Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
In Reply: Dr Lohman's primary concern is that stratified care based on disability may lead to overtreatment with triptans. He indicates that when clinicians use stratified care, some patients who met minimal criteria for treatment success with aspirin plus metoclopramide may receive a triptan. Success in our trial was defined as achieving mild or no pain within 2 hours in 2 of 3 attacks. Treating a patient who achieves this level of success with a triptan may not constitute "overtreatment." In 1 study, less than 25% of patients with mild pain at 2 hours (a nominal success) were satisfied with their therapy.1 Contrary to Lohman's assertion, many patients who use triptans also use other agents; de-escalating treatment is common in clinical practice.
Lipton RB, Stewart WF, Stone AM, Sawyer JPC, Láinez MJA. Treatment Strategies for Migraine Headache—Reply. JAMA. 2001;285(8):1014-1015. doi:10.1001/jama.285.8.1013